HIV: traditional risk factors account for a significant proportion of morbidity

  • Althoff KN & al.
  • Lancet HIV
  • 22 Jan 2019

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Traditional risk factors account for a larger burden of non-AIDS-defining cancer, myocardial infarction (MI), and end-stage renal and liver disease vs HIV-related risk factors in HIV-infected, virally suppressed adults.

Why this matters

  • HIV viral suppression post-antiretroviral therapy (ART) initiation should be balanced with regular screening for traditional risk factors for non-AIDS-defining cancers, MI, end-stage liver, renal disease/events.
  • Consider effective interventions targeted toward non-HIV-related conditions to reduce risk, morbidity.

Key results

  • 61,500 participants across 21 cohorts.
  • Greater number of participants with smoking history, hepatitis C and B, low CD4 cell count (
  • Population-attributable fractions (PAFs):
    • Non-AIDS-defining cancer: smoking (24%; 95% CI, 13-35); MI (37%; 95% CI, 7-66);
    • MI: elevated total cholesterol (44%; 95% CI, 30-58); hypertension (42%; 95% CI, 28-56);
    • Liver disease: hepatitis C (30%; 95% CI, 21-39); low CD4 cell count (19%; 95% CI, 12-26);
    • Renal disease: hypertension (39%; 95% CI, 26-51).

Study design

  • Prospective multicohort estimation of proportion of non-AIDS-defining cancers, MI, end-stage liver, renal disease/events attributable to traditional and HIV-related risk factors among HIV-infected US and Canadian adults with successful care linkage.
  • Funding: NIH; CDC.

Limitations

  • Potential underestimation of PAFs.
  • Additional preventable/modifiable risk factors not considered.
  • Causation undetermined.